| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,567 |
3,521 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
3,576 |
3,535 |
$80K |
| D0274 |
Bitewings - four radiographic images |
1,446 |
1,419 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
305 |
$22K |
| D1206 |
Topical application of fluoride varnish |
898 |
890 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
31 |
28 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
352 |
202 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
427 |
420 |
$18K |
| D1120 |
Prophylaxis - child |
387 |
383 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
114 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
652 |
635 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
238 |
201 |
$3K |
| D2954 |
|
16 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$300.00 |
| D1999 |
|
58 |
58 |
$0.00 |